根治性前列腺切除术后放疗对复发模式的影响差异：使用[Ga]Ga-PSMA 配体 PET/CT（MRI）评估。
Differential impact of radiation therapy after radical prostatectomy on recurrence patterns: an assessment using [Ga]Ga-PSMA ligand PET/CT(MRI).
机构信息
Department of Urology, Medical University of Vienna, Vienna, Austria.
Workinggroup of Diagnostic Imaging in Urology, Austrian Society of Urology, Vienna, Austria.
出版信息
Prostate Cancer Prostatic Dis. 2021 Jun;24(2):439-447. doi: 10.1038/s41391-020-00294-0. Epub 2020 Sep 29.
PURPOSE
To evaluate the differential impact of postoperative radiotherapy (RT) on recurrence patterns in patients treated with radical prostatectomy (RP) using [Ga]Ga-PSMA conjugate 11 positron emission tomography (PSMA 11-PET).
METHODS
We assessed 162 consecutive patients who experienced biochemical recurrence (BCR) after RP for nonmetastatic prostate cancer (PC). All had at least one positive lesion on imaging. No patient was on androgen deprivation therapy (ADT). Patients were categorized into those who had received adjuvant/salvage RT ± ADT and those who did not (RP only). Lesion- and patient-based analyses were performed. The impact of the radiation field was assessed.
RESULTS
Overall, 57 BCR patients underwent RP only, 105 received postoperative RT. Median PSA was 1.01 ng/ml (IQR 0.58-2). In the lesion-based analysis, compared to the RP only patients, those who had received postoperative RT, had less lymph node (LN) recurrences distal to the common iliac bifurcation (35.2 vs. 57.9%, p = 0.05), but were more likely to harbor positive LNs proximal to the iliac bifurcation and in the presacral (34.2 vs. 12.3%, p = 0.002) areas as well as bone metastases (25.7 vs. 8.8%, p = 0.01). In the patient-based analysis, the patients with postoperative RT after RP had less recurrence in the pelvis only (pelvic LNs and/or prostate bed) (52.4 vs. 79%, p = 0.002), but were more likely to harbor extrapelvic recurrence (41.9 vs. 15.8%, p = 0.001). Patients who received RT to the prostate bed only had more recurrence to the pelvic LN only (54.2% vs. 23.4%, p = 0.002), but less extrapelvic recurrence (31.3 vs. 53.2%, p = 0.03) and less bone recurrence (16.7 vs. 36.2%, p = 0.031) compared to those patients, who received RT to the prostate bed and pelvic nodes.
CONCLUSIONS
Postoperative radiation treatment alters the recurrence pattern in BCR patients after RP. Further prospective studies are needed to establish a decision tree for optimal imaging/management according to previous treatments.
目的
使用 [Ga]Ga-PSMA 结合物 11 正电子发射断层扫描（PSMA 11-PET）评估根治性前列腺切除术（RP）后接受术后放疗（RT）对复发模式的差异影响。
方法
我们评估了 162 名连续接受 RP 治疗的非转移性前列腺癌（PC）患者，这些患者在 RP 后出现生化复发（BCR）。所有患者在影像学上均有至少一个阳性病灶。没有患者接受雄激素剥夺治疗（ADT）。患者分为接受辅助/挽救性 RT±ADT 治疗和未接受治疗（仅 RP）的患者。进行了基于病变和患者的分析。评估了辐射场的影响。
结果
总体而言，57 名 BCR 患者仅接受 RP，105 名患者接受术后 RT。中位 PSA 为 1.01ng/ml（IQR 0.58-2）。在基于病变的分析中，与仅接受 RP 的患者相比，接受术后 RT 的患者在髂总分叉远端的淋巴结（LN）复发较少（35.2%比 57.9%，p=0.05），但更有可能在髂分叉近端和骶前（34.2%比 12.3%，p=0.002）区域以及骨转移（25.7%比 8.8%，p=0.01）中存在阳性 LN。在基于患者的分析中，接受 RP 后术后 RT 的患者在骨盆中仅（骨盆 LN 和/或前列腺床）的复发较少（52.4%比 79%，p=0.002），但更有可能发生骨盆外复发（41.9%比 15.8%，p=0.001）。仅接受前列腺床 RT 的患者在骨盆 LN 中仅出现更多复发（54.2%比 23.4%，p=0.002），但骨盆外复发较少（31.3%比 53.2%，p=0.03），骨复发较少（16.7%比 36.2%，p=0.031）与接受前列腺床和骨盆淋巴结 RT 的患者相比。
结论
术后放疗改变了 RP 后 BCR 患者的复发模式。需要进一步的前瞻性研究来根据先前的治疗建立最佳影像学/管理的决策树。
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